Case study: Pulmonary Nodule Risk smartphone app

Developed by Cancer Research UK in partnership with BTS

In partnership with the British Thoracic Society, Cancer Research UK has produced an iPhone app which includes the risk calculators and summary information from the BTS guideline

Matt Wickenden, Cancer Intelligence Manager at CR-UK, explains how he worked with teams across the charity to coordinate and manage the development of this digital tool for health professionals

The app is now also available on Android devices as well as iPhone, and has been updated to incorporate some improvements suggested by app users.

Background

The role of smartphones in everyday life is constantly growing, and that includes supporting the world of medicine.

Apps in particular have the potential to offer quick and simple answers to some of the key questions doctors face every day. Teams at Cancer Research UK and across thehealthcare sector are excited about the prospect of improving cancer care by making use of these new technologies. But we want to understand whether they can actually prove popular with clinicians, and that they can be reliable and effective.

Our goal was to make it easy for health professionals to access comprehensiveGuidelines published in 2015by the Society on how to manage patients with small tissue growths, called pulmonary nodules, that can appear on lung scans. These nodules can be harmless, but they can also be cancerous and need treatment.

The BTS guidelines offer clinicians information to help diagnose patients with lung cancer as quickly as possible, and without carrying out unnecessary tests.

However hospital staff need to move around a lot, so reading the guidelines on a computer isn’t easy or practical. So the aim of our app was to help them access the information they need wherever they may be in the hospital.

Image: A solid pulmonary nodule (small white dot mid left of the image) seen on a CT scan of a patient’s lungs. Source: BTS

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Implementation

From the start we wanted to ensure that the design and functionality of the app did exactly what the doctors needed it to.

First we collected feedback from 18 health professionals, finding that 11 (61%) were already using smartphone apps for their work at least several times a month, with 3 (17%) using them several times a day. The feedback also showed that 11 (61%) were very likely to use an app version of the guidelines and calculators.

We then worked with our in house digital experts to develop a prototype app that we took to hospitals in Leeds and London to understand how doctors might use it.

As we were already aware, doctors and their teams were constantly on the move around the hospitals we visited. We also found that there are a number of different medical roles that use the Guidelines, all with slightly different needs. For example, the nurses carrying out scans and tests on patients might use the app in a different way to the doctors interpreting the results from those scans.

The easier we could make it for different people to access what was relevant to them, without having to spend lots of time referring back to the full Guidelines, the better.

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Findings

We’ve had fantastic feedback on the app. It has been downloaded 2,278 times, which is over 4 times the initial target, in under 6 months.Most of those were in the UK/US, China, The Netherlands, and Japan.

Users have said they find the app easy to navigate and quick to use. They also appreciate that it’s accessible offline and that it offers options for different calculators. A respiratory trainee says:

“Algorithms are laid out in a way that means you can actually review and use them on the go. The whole app is designed in a way that makes it nice to use. The icon, colour-scheme, and layout are really clear and pleasant; it’s really great to see this level of design in this kind of app.”

We wanted to make sure that the app would do more than just replicate what was already available through the BTS website. Displaying the quite complicated and detailed BTS Guidelines as clearly as possible was a particular challenge.

We were able to do this by testing a number of design options with different groups, including Cancer Research UK staff and clinical teams. Their feedback gave us confidence in our designs and ultimately saved us time ‘guessing’ how people would want the guideline information presented.

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Learnings

This project really highlighted the value of involving the users of your innovation in every step of its development. The clinical teams we spoke to consistently gave us valuable information and new ideas, as well as the confidence to demonstrate to our senior stakeholders that the project was going in the right direction.

The main aspect that could have been improved would have been testing more simple mock ups of the designs for the app, in the quickest and simplest way possible, before we involved our IT developer. This would have avoided the need to re-do work on the app itself, thus saving time. Overall though we’re really pleased with how the project went as well as the response we’ve had to the app.

We have now updated the existing iPhone app to incorporate some improvements suggested by our users. This app is now available on Android devices, to give more people access to it.

Matt Wickenden is currently on secondment with PHE as Systemic Anti-Cancer Therapies (SACT) Dataset Programme Manager. Please contact Tom Lee, Senior Manager of Intelligence Partnerships and Products at Cancer Research UK, if you have questions about this innovation: Tom.Lee@cancer.org.uk